A Premier Gynecology and Obstetrics Group in Colorado Springs

Patient Forms

For your convenience and in an effort to reduce the amount of time spent in our office completing the necessary paperwork, Academy Women’s Healthcare Associates have made the forms available to you online.
arrowpATIENT Health questionaire

This health form is to be completed by first time patients in order to obtain information regarding health history.

Please print a copy of this form and complete it prior to coming for your first office visit.

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arrowpATIENT REGISTRATION FORM

This registration form is to be completed every year in order to process insurance claims correctly and to have updated information on file at AWHA.

Please print a copy of this form and complete it prior to coming for your first office visit or upon request.

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arrowRecords Release Form

This form authorizes the release of health information to a third party.

When requesting release of your health records to a third party, please print a copy of this form. After completing it, fax (719.622.3400) or drop the form off at our office, attention: Andre Beach.

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arrowInformation Authorization Release consent Form

This form will allow us to release information about you, the patient, to individual(s) who are non-medical in relation. This consent form can be changed by the patient at anytime for any reason.

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arrowRIGHT TO PRIVACY NOTICE

This form provides notice to all practice patients of their right to privacy of their protected health information (PHI). This policy describes procedures implemented by the practice to ensure the privacy of PHI.

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